The Current State of Niacin in Cardiovascular Disease Prevention
Open accessAbstract
Objectives This study sought to assess the efficacy of niacin for reducing cardiovascular disease (CVD) events, as indicated by the aggregate body of clinical trial evidence including data from the recently published AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Outcomes) trial.Background Previously available randomized clinical trial data assessing the clinical efficacy of niacin has been challenged by results from AIM-HIGH, which failed to demonstrate a reduction in CVD event incidence in patients with established CVD treated with niacin as an adjunct to intensive simvastatin therapy.Methods Clinical trials of niacin, alone or combined with other lipid-altering therapy, were identified via MEDLINE. Odds ratios (ORs) for CVD endpoints were calculated with a random-effects meta-analyses. Meta-regression modeled the relationship of differences in on-treatment high-density lipoprotein cholesterol with the magnitude of effect of niacin on CVD events.Results Eleven eligible trials including 9,959 subjects were identified. Niacin use was associated with a significant reduction in the composite endpoints of any CVD event (OR: 0.66; 95% confidence interval [CI]: 0.49 to 0.89; p = 0.007) and major coronary heart disease event (OR: 0.75; 95% CI: 0.59 to 0.96; p = 0.02). No significant association was observed between niacin therapy and stroke incidence (OR: 0.88; 95% CI: 0.5 to 1.54; p = 0.65). The magnitude of on-treatment high-density lipoprotein cholesterol difference between treatment arms was not significantly associated with the magnitude of the effect of niacin on outcomes.Conclusions The consensus perspective derived from available clinical data supports that niacin reduces CVD events and, further, that this may occur through a mechanism not reflected by changes in high-density lipoprotein cholesterol concentration.
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A subsequent meta-analysis of 11 outcome studies indicated that niacin reduced cardiovascular events and adverse coronary endpoints by 34% and 25%, respectively.
“A subsequent meta-analysis of 11 outcome studies, which were mainly conducted in secondary prevention and included the AIM-HIGH-study [92], indicated that niacin reduced cardiovascular events and adverse coronary endpoints by 34 and 25%, respectively [94].”
From HDL cholesterol: reappraisal of its clinical relevance (2017) · cites this paper as [94]
Meta-analyses of studies with niacin, mostly without simultaneous administration of statins, indicate a decrease in cardiovascular events.
“Meta-analyses of studies with niacin (mostly without simultaneous administration of statins) indicate a decrease in cardiovascular events [92–94].”
From HDL cholesterol: reappraisal of its clinical relevance (2017) · cites this paper as [94]
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- Authors
- Lavigne, P. M., & Karas, R. H.
- Affiliations
- Tufts Medical Center (US)
- Corresponding author
- Karas, Richard H.
- ORCID
- Karas, Richard H.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2013-01
- Volume
- 61
- Issue
- 4
- Pages
- 440-446
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2123068849
- Cited by
- 185
- References
- 55
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 5 · 2023: 9 · 2022: 8 · 2021: 3 · 2020: 10 · 2019: 11 · 2018: 13 · 2017: 16 · 2016: 12 · 2015: 29 · 2014: 25 · 2013: 35 · 2012: 1
- FWCI
- 5.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (T32HL069770)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
- Keywords
- nicotinic acid, cardiovascular disease prevention, AIM-HIGH trial, HDL cholesterol, coronary artery disease, stroke, simvastatin, lipid-lowering therapy, meta-regression, non-HDL cholesterol
- MeSH terms
- Hypolipidemic Agents, Cardiovascular Diseases, Humans, Cholesterol, HDL, Niacin, Regression Analysis, Incidence, Randomized Controlled Trials as Topic, Treatment Outcome, Risk Assessment, Stroke
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